A broken bone in the hip or pelvis needs to be set and stabilized in order to heal fully. Reduction is the process of setting the bone or reassembling the bone fragments. Fixation is a procedure used to prevent bone fragments from moving while new bone tissue grows, and fuses the pieces into one solid bone.
Open and Closed Reduction
Depending on the location and severity of the fracture, a surgeon may perform an open or closed reduction.
In a closed reduction, a less invasive procedure, the surgeon makes small incisions near the broken bone and uses surgical instruments to reassemble the bone fragments. Closed reduction may be appropriate for simple fractures that don’t involve many bone fragments and haven’t broken the skin. A closed technique may minimize damage to surrounding soft tissues and speed healing.
In an open reduction, the surgeon makes an incision over the injured area to view the pieces of broken bone and assess how well they can be put back together. Open reduction is required for open fractures, in which a bone breaks through the skin. This technique is also needed when fractured bones have broken into many pieces, some of which are displaced, or out of position. Open reduction is used if bone fragments are so small that they need to be removed. Doctors may need to perform this procedure if they weren’t able to reassemble bone fragments in the correct position during a closed reduction.
Because the acetabulum, or hip socket, is located behind the leg bone and therefore is difficult to access, any fracture in this part of the pelvis requires an open reduction.
Internal and External Fixation
After the fractured bone has been reduced, a surgeon uses one or more fixation devices to keep the bone fragments in position while the bone heals. Most of the time, surgeons use internal fixation, a technique involving stainless steel screws, plates, wires, and rods to permanently fix the bone fragments together.
The surgeon determines the most appropriate fixation device depending on the location and severity of the fracture.
If a fracture occurs as the result of a traumatic, life-threatening accident, such as a car crash, a surgeon may stabilize the bone with an external fixation device. This allows doctors to focus on repairing internal organs, blood vessels, and nerves. Later, surgeons may perform additional procedures to permanently fix the bone fragments in place.
In external fixation, surgeons insert metal pins into the bones on each side of the hip or pelvic fracture, then connect those pins to a frame that extends outside the body. This frame joins together any displaced pieces of bone and keeps the bones stable.
This type of external brace is used only for fractures accessible from the front of the body. A fracture at the rear part of the pelvis requires surgery using alternative fixation techniques.